Youth perspectives on how social influences impacted nicotine vaping cessation: A qualitative thematic analysis

Abstract

Background

It is well known that social influences play a major role in nicotine vaping uptake among youth. However, little is known about how these influences play a role in nicotine vaping cessation. This research article examines the complex social influences on youth nicotine vaping cessation.

Methods

Following a qualitative descriptive design, fifteen semi-structured interviews were conducted with youth ages 16 to 24 who had experiences with nicotine vaping and cessation. Inductive thematic analysis was employed to extract themes.

Results

Four key themes emerged, including (1) limited effect of social networks on decision to quit; (2) nicotine vaping/ex-nicotine vaping community influences nicotine vaping cessation journeys; (3) seeking support from social networks may be contingent on the nature of the relationship; and (4) normalization of nicotine vaping cessation could be helpful in nicotine vaping cessation journeys.

Conclusions

This study underscores a crucial gap in existing cessation interventions, which often overlook the social dimensions of quitting, and emphasizes the need for comprehensive programs that normalize cessation, reduce stigma, and promote supportive environments. Policies and programs would benefit from fostering social norms that support quitting behaviors and creating accessible resources to empower youth in their cessation journeys.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28355-4.

Introduction

The nicotine vaping epidemic is beginning to garner considerable attention in both academic literature and public discourse as a pressing public health issue. The widespread proliferation of nicotine vaping among youth is epitomized by the 2022 statistics that 30% of Canadian adolescents aged 15 to 19 and 48% of young adults aged 20 to 24 reported having tried nicotine vaping at some point, with 13% and 18% having vaped in the previous 30 days, respectively [1]. Higher rates of past 30-day use are exhibited amongst male youth compared to female youth [1]. Alarmingly, this 30-day prevalence is almost 120% higher compared to the 2017 Canadian pre-legalization of nicotine vaping statistics that only 6% of young Canadians reported nicotine vaping within the past 30 days [2].

While there is emerging literature on the driving factors behind youth nicotine vaping initiation (e.g. curiosity, peer pressures, enjoyment, stress reduction, combustible cigarette cessation strategy) [3–7] and cessation (e.g. health concerns, cost, social influence) [8, 9], there remains a gap in understanding how nicotine vaping cessation is influenced by the complex social contexts in which cessation is situated. As such, this paper seeks to delve into the social influences experienced by youth who vape. By synthesizing existing literature and exploring youth perspectives on how their social contexts impact their nicotine vaping cessation journey, this paper aims to elucidate critical determinants that can inform the future development of targeted interventions and support strategies for youth striving to quit nicotine vaping successfully.

What is particularly unique about nicotine vaping today is how it has become embedded within youth cultures; this is largely due to how the tobacco industry has marketed nicotine vaping strategically toward youth audiences, with flavoured products, customization/personalization, sleek and discreet designs, and media campaigns [10–15]. Despite age restrictions on purchasing nicotine vaping products in Canada, youth participants in Coen et al. [16] voiced that nicotine vaping products are exceptionally easy to access through various means, such as social sources, brick-and-mortar stores, and online retailers. Easy access to nicotine vaping products, aggressive marketing, and the lack of stringent regulations contribute to the widespread availability and acceptability of nicotine vaping among youth and have contributed to the normalization and glamorization of using these products, thereby embedding nicotine vaping into youth cultures and social contexts [4–7, 10].

Findings from Han and Son [13] and Rocheleau et al. [17] demonstrate that higher levels of peer nicotine vape use are associated with increased odds of personal nicotine vape use among youth. Multiple features of schools, such as social norms, limited capacity to sanction risky behaviours, and perpetual stressors (e.g. grades, homework), play a significant role in youth nicotine vaping and decision-making [6, 7]. In examining the impact of the school environment, it was confirmed that the risk of nicotine vaping consistently rises when witnessing vape use at school [13]. Coen et al. [16] and Crane et al. [5] highlight micro-geographies within the school environment, specifically washrooms, as critical areas where youth are frequently exposed to and access nicotine vaping. Coen et al. [16] posit that these micro-geographies of nicotine vaping within schools are correlated with the construction of social hierarchies and are sites of potential and actual physical (e.g. secondhand vapour exposure) and emotional risk for youth. Peer groups facilitate the reproduction of nicotine vaping behaviours by creating environments where nicotine vaping is not only accepted but encouraged as a mediator of social connections and status [7, 14, 16, 17]. Interestingly, more males reported friends pressuring them to vape relative to females, whereas more female vapers perceived social media exposure to be the most decisive influence for nicotine vaping initiation [4].

Social media seems to have rapidly perpetuated the integration of nicotine vaping into youth cultures. Research suggests that social media presents as a risk due to the limited ability to regulate audience, content, and spread, resulting in the potential to inadvertently advertise and virally circulate nicotine vaping-related content [11, 14, 18]. Indeed, the findings of Vogel et al. [19] indicate that greater social media use and heavier exposure to advertisements and nicotine vaping content in social media posts are correlated with a greater risk for nicotine vape use among youth. Youth often encounter ‘vape tricks’ videos and influencers who portray nicotine vaping as a status symbol, validating and elevating these practices through likes, shares, and comments [16]. The concomitant normalization and glamorization of nicotine vaping behaviours online and in person make it challenging for individuals to resist the social pressures associated with nicotine vaping or to quit once they start. To this point, youth are at a developmental stage where they are establishing their social identity, making them acutely vulnerable to forming an identity as a vaper [20].

Parents influence youth in several ways, including as role models (both positive and negative) [5, 21]. McCausland et al. [14] highlight that a lack of parental knowledge about e-cigarettes can facilitate youth nicotine vaping, while parents who are aware of their child’s whereabouts and have strong relationships with them can act as protective factors [22]. Many parents lack an understanding of the risks of nicotine vaping and may not recognize the look, smell, and attributes of nicotine vaping products [5]. Han and Son’s [13] systematic review identified tolerant parental attitudes toward nicotine vaping as a recurrent risk factor. These authors also consistently found that youth are at increased risk of adopting nicotine vaping behaviours if they live with nicotine vaping users or if tobacco use is permitted in the home environment.

Despite how prolific nicotine vaping has become in the day-to-day lives and social contexts of youth, most youth report wanting to quit; 60% according to Health Canada [1]. Unfortunately, however, many youth who attempt to quit nicotine vaping experience relapses or struggle with sustained abstinence, indicating an urgent need for targeted cessation strategies that address the unique challenges faced by this demographic [4, 5, 23]. While it is understood that the social contexts of youth may be a barrier to cessation [9, 24], it is yet unclear what role social networks can play in supporting youth in their quit journeys. Given the influence that social networks have on health behavior decision-making among youth, particularly nicotine vaping uptake [6, 7, 16], understanding their role in nicotine vaping cessation is urgently needed. As such, this paper seeks to delve into the social influences experienced by youth during their nicotine vaping cessation journey by posing the question: What are youth perspectives on how social influences affect their nicotine vaping cessation experiences?

Methods

This study

The present study is part of a larger qualitative study examining socio-environmental influences on nicotine vaping cessation among youth, which includes digital technologies, social networks, and youth cultures that hallmark the modern-day contexts of youth. The larger study included a dual focus on youth experiences with using nicotine vaping cessation apps, and social influences on their nicotine vaping cessation experiences. This paper presents on the latter, with the findings consistently situated in the context of app-using youth.

Design

Underpinned by constructivism (that subjective realities exist and can be known through individuals’ subjective accounts of their experiences) [25], we employed a qualitative descriptive design. Qualitative description is ideal for exploring and describing phenomena that remain understudied [26], like how youth social experiences impact their nicotine vaping cessation journeys. This study was approved by the University of British Columbia’s Okanagan Behavioral Research Ethics Board (#H22-01408) in summer of 2022. The recruitment process and interviews occurred simultaneously in the fall of 2022.

Sampling and recruitment

This study focused on youth experiences with nicotine vaping since this age demographic exhibits the highest rates of regular, daily nicotine vaping in Canada [1]. A purposive sampling strategy was used to recruit who would best be able to answer the research questions based on their lived experiences. Youth between the age of 16–24 were eligible for this study if they (i) were actively nicotine vaping or vaped in the past, (ii) are currently or were previously motivated to quit, (iii) are using or used a nicotine vaping cessation app in the past, (iv) live in Canada, (v) speak English fluently. A recruitment ad was circulated on social media (Instagram and Facebook). This ad invited youth to talk to UBC researchers about their experience quitting or trying to quit nicotine vaping. It included a link and QR code that led them to our eligibility survey which comprised 5 “yes or no” questions. The research team received a list of all eligible youth. The research team tried to select an equal number of female and male participants. In the end, a total of 10 female (all self-identified as women) and 7 male (all self-identified as men) participants were included. Eligible youth were sent an email asking them for consent and their availability in order to schedule an interview. Given that 16 is the age of consent in Canada, parental consent was not required for any participants in this study. A demographic questionnaire was attached to the email. The interviews occurred after consent was received and the principles of informed and on-going consent was reviewed with youth at the start of each interview. Participants were compensated with a 50 CAD e-gift card for their involvement.

Demographic table/ sample

Demographic	Category	n	%
Gender	Female (Young woman)	10	58.8
	Male (Young man)	7	41.2
Age	16–17	3	17.6
	18–24	14	82.4
Province	British Columbia	7	41.2
	Ontario	6	35.3
	Quebec	4	23.5
Length of time nicotine vaping in years	< 2	6	35.3
	2–3	2	11.8
	4–5	7	41.2
	≥ 6	2	11.8
Currently trying to quit	Yes	13	76.5
	No	4	23.5
Frequency nicotine vaping	Several times/day	11	64.7
	Once/day	3	17.6
	A few times/week	3	17.6
	≤ Once per week	0	0
Quit attempts	Once	6	35.3
	2–5 times	8	47.0
	6–10 times	2	11.8
	> 10 times	1	5.9
# of friends who vape	None of them	0	0
	Some of them	7	41.2
	Most of them	8	47.0
	All of them	2	11.8

Data collection

The interview guide was developed in collaboration with researchers in the field and a youth co-researcher. It was sent to the rest of the team for review and edits. The final interview guide contained two parts and 28 questions in total, made up of a mix of both open-ended and closed-ended questions. Part two, which included 15 questions, was used to inform this paper. These questions focused on the social contexts of youth as they were trying to quit. For example, “Out of the people you are comfortable talking to about quitting nicotine vaping, how do these people view nicotine vaping? Do they consider nicotine vaping acceptable?” and “Does quitting nicotine vaping negatively and/or positively impact aspects of your social life?” The full interview guide is available as a supplement.

Seventeen semi-structured interviews were conducted online and recorded via UBC Zoom with the consent of the participants. Interviews were held in September and October of 2022. The research team was located in British Columbia, Canada and the participants resided in various provinces across Canada. Each interview was held by one of four trained Research Assitants (RAs) (DR, RN, CY, and TA) and ranged from 30 to 60 min in length. The RAs followed the preset interview guide, while allowing participants to elaborate on their experience using the interview questions as a guide. Interviews occurred simultaneously with recruitment based on participant availability. Recruitment stopped when the team felt that the data was saturated and no new data was required to rigorously answer the research question.

Data analysis

After completing all the interviews, interview recordings were uploaded to the Otter.ai program where they were automatically transcribed. Each transcription file was reviewed by a RA to ensure accuracy and anonymized by removing participant identifiers. Edits were made by a RA if there were any discrepancies due to software inaccuracies. The transcribed interview files were uploaded on the NVIVo 14 software. Two RAs (RN and DR) organized all relevant data from the interview transcripts into codes that aligned with the interview questions to allow for further analysis. Following a recursive process, the research coordinator (MT) and principal investigator (LS) used an inductive thematic analysis approach to identify overarching themes from the coded data, following Braun and Clarke’s [27] six steps to thematic analysis, which include familiarization, initial coding, searching for themes, reviewing themes, defining themes, and reporting [27]. Thematic analysis pushes researchers to further explore their data beyond the initial codes and identify patterns and meaning across their whole data set, generating well defined themes in the end [27]. After reading and re-reading the transcripts (familiarization) and initial codes (initial coding) developed by DR and RN, the team worked together to identify the themes present throughout the dataset (searching for themes). Frequent team meetings were held to discuss the emerging themes (reviewing themes) and finalize the results (defining themes). To maintain the rigor and trustworthiness of the analysis process, the researchers engaged in ongoing recursive analysis of the data, where reflexive practice was prioritized (e.g., discussing any biases) [27].

Results

Participants described how various social influences affected their nicotine vaping cessation journeys. Findings from this study were organized into the following four themes: limited effect of social networks on decision to quit; nicotine vaping/ex-nicotine vaping community influences nicotine vaping cessation journeys; seeking support from social networks may be contingent on the nature of the relationship; and normalization of nicotine vaping cessation could be helpful in nicotine vaping cessation journeys. These themes are described in more detail below.

Limited effect of social networks on decision to quit

Amongst both male and female participants, the decision to quit nicotine vaping was often made independently. Participants’ cessation journeys were also commonly solitary, without direct support from their social networks. In most cases, this was an intentional choice, although youth gave several different reasons for this decision. These are captured in the following three sub-themes: self-accountability and responsibility; shame and disappointment; and, out of sync.

Self-accountability and responsibility

Youth often felt individually responsible for their nicotine vaping behaviour and accountable for their quitting journeys, compelling them to quit independently. Explaining why she quit nicotine vaping on her own, one participant emphasized her personal responsibility: “If you’re an adult, take the risk, self-responsibility, don’t put it on others… Self-accountability is the first step to getting out of the situation that you’re in and getting help” (#7, F, 18, BC). Participants felt that they could only rely on themselves to be successful in quitting, especially during cravings:

To really decide I’m going to stop doing something, it has to be me and I have to be confronted myself, I can’t be surrounded by others…Because when these urges come, it’s exactly when you’re alone, really…I think the best thing to do is face it head on. (#3 F, 23, QC)

Similarly, another youth reflected, “you can’t really count on other people to keep you accountable. If you really want to quit, you kind of have to do it yourself, you have to make that decision” (#4, F, 24, QC).

Shame and disappointment

The emotional challenges accompanying quitting compelled others to go through the journey on their own. Some youth experienced disappointment and frustration as they tried to quit, which they preferred to keep to themselves. For instance, one participant shared, “I don’t really like talking about [quitting] that much. It’s actually something very personal and I get disappointed and frustrated. It’s something that affects my own self-image” (#15, M, 20, BC). Fear of disappointing others also compelled private journeys towards quitting: “I like to handle it by myself. I think that’s partially because if I do relapse, I won’t have someone weighing down on me, and I wouldn’t disappoint someone- I only have to deal with disappointment within myself” (#1, F, 18, ON).

In other cases, participant concerns of how nicotine vaping would be perceived prevented openness with their support networks. As one youth shared, “I was a little more ashamed of [nicotine vaping] back then. So I’m not sure they [family and friends] could have provided the best support at that time, because I wasn’t really very honest or open at the time” (#7, 18, F, BC). For this youth, feelings of shame for nicotine vaping prevented her from engaging others in her quitting journey.

Out of sync

Quitting on their own was not always an intentional decision. In some cases, participants’ decisions to quit were out of sync with their social circles who continued to vape, requiring them to navigate their quitting journeys on their own. One youth, for example, expressed regret that none of her friends who vaped were also quitting and as a result, she was quitting on her own (#11, F, 18, BC) while another youth said, “I was quitting alone… My best friend was also nicotine vaping at the same time as me, and she continued while I was trying to quit” (#1, F, 18, ON). Another youth shared that since his peer group continued to vape, it was necessary to remove himself from social situations where others were nicotine vaping, affecting his social relationships and compelling him to quit alone: “I haven’t been going to parties that much in the last few years. The times that I’ve been trying to quit, I’ve been pretty socially estranged from people. So it’s kind of been my own prerogative to get this done” (#18, M, 24, BC). For these youth, quitting alone was the result of the absence of peers also embarking on cessation journeys.

Nicotine vaping/ex-nicotine vaping community influences nicotine vaping cessation journeys

While most participants attempted to quit without direct support from others, their efforts and success were indirectly affected by other individuals who currently vaped, had attempted to quit, or were in the process of quitting. Peers, as well as those outside of participants’ social networks, facilitated or hindered participants’ cessation journeys, albeit in different ways and to varying extents. These experiences are captured under two main sub-themes: nicotine vaping community is a barrier to cessation, and shared experience of quitting is helpful for cessation.

Nicotine vaping community is a barrier to cessation

The influence of active vapers posed a challenge to several participants as limited support from other vapers, both friends and strangers, often made quitting more difficult. Participants perceived active vapers’ unwillingness to listen or offer encouragement as unsupportive of their cessation goals. One youth shared with vapers in her social network that she was quitting, but did not engage them in her quitting journey because “since they’re all actively using, they don’t really want to hear about it all” (#11, F, 18, BC). In other cases, lack of support from fellow vapers was more overt, and was perceived to alter relationships. For example, one youth shared that “I think some of my friends didn’t like [that I was quitting]. I think they stepped back from our little friend group” (#9, F, 17, ON). These responses from their nicotine vaping peers made participants feel less supported during their cessation journeys.

As vapers, the influence of others who vaped also made it more difficult to maintain a commitment to quitting. Witnessing others nicotine vaping posed a challenge to their nicotine vaping cessation journeys. Often, this included friends in participants’ close social networks. Reflecting on their cessation journey, one participant shared,

When I was wanting to quit I was pretty young, it was hard- fifteen or sixteen wanting to quit. So when you’re at that age, you’re very heavily influenced, especially by your friends. And being around the constant circle of friends who vaped, I felt like I couldn’t get out of it. (#7, F, 18, BC)

Observing others nicotine vaping in public settings triggered participants’ desire and could divert their efforts to quit. One youth felt prepared to minimize the influence of friends whom he knew vaped, however, the effect of being exposed to nicotine vaping in public spaces was particularly strong because it was often unanticipated. According to this participant,

People at the bus stop and walking around downtown influenced me to [vape] more than if I was hanging out with a friend and he had his vape. But it’s because I’m prepared. [My friend is] in my life, I know they [vape], I’m ready for that… It’s those unexpected times. Say you’re driving around and your window is open, smell it walking in the neighbourhood. That I find is more of a societal pressure- just it’s everywhere kind of thing. (#18, M, 24 BC)

The influence of other vapers caused one participant to add distance between herself and her nicotine vaping friends to limit their influence: “A lot of the people who I hang out with do vape and if I am planning on quitting nicotine vaping then I cannot go out with them anymore because they will be nicotine vaping and that would trigger me” (#13, F, 21, ON). Nicotine vaping amongst both peers and strangers presented barriers to participants’ cessation journeys.

Shared experience of quitting is helpful for cessation

The common experience of quitting positively affected cessation journeys for some youth. Although participants most often quit alone, learning about the experiences of others who had successfully quit or who were also attempting to quit offered inspiration, encouragement, or guidance. Participants found that both peers and strangers who had also quit positively impacted their cessation experiences. Youth felt encouraged in their quitting attempts through the knowledge that they were not alone and by learning about others’ similar endeavours towards quitting. Being able to relate to others’ experiences was encouraging, because “they were all on the same journey” (#9, F, 17, ON). Others who had quit or attempted to quit offered advice that aided participants during their cessation journeys. As one youth reflected, “Talking to people who have gone through the experience is much more helpful. They can put themselves in your shoes a lot better, they understand your situation, and they’re able to really help you” (#7, F, 18, BC).

Encouragement often came from members of participants’ immediate social networks who had a common experience of quitting. One youth, for instance, felt supported by a friend who had previously attempted to quit because of his ability to relate to the challenges of quitting: “It’s something that both have the same purpose of doing. If I do run into any problems, or let’s say I couldn’t control myself, I realised that this is definitely someone I could go to” (#2, M, 17, ON). By contrast, other participants felt more comfortable seeking support from strangers who had quit. As one youth expressed, “I am more comfortable going out, mingling, moving out of my friends [group] and by means of doing that, I could actually talk with some person- ‘Oh man, I’m going through this’, with some other person who is in a similar situation or wants to quit” (#19, M, 21, BC). Encouragement and advice from others who had common experiences of quitting provided valuable support as participants navigated their cessation journeys.

Seeking support from social networks may be contingent on the nature of the relationship

Participants shared several relational considerations that affected their willingness to seek or receive quitting support from their social networks. Youth felt that relational closeness, the presence of trust or judgement, and appropriateness of sharing with certain networks impacted who they engaged in their cessation journeys. Participants discussed these considerations in actual as well as theoretical terms. Since most youth did not engage their social networks in their cessation decisions or journeys, youth most frequently shared barriers or limitations within relationships to justify their decision not to seek social support. However, youth outlined contingencies that needed to be in place for them to feel comfortable seeking support from individuals within their networks.

Decisions to share or not share nicotine vaping cessation journeys were frequently influenced by perceived relational closeness. Generally, participants were more likely to seek or consider seeking support in strong, established relationships such as with family or friends, and were less likely to seek support from relationships where they perceived greater emotional distance and unfamiliarity: “I would feel most comfortable talking to my friend group just because they aren’t a parental figure towards me… I feel like I’d be more open to talking about my struggle with quitting and wanting to quit in the first place” (#1, F, 18, ON). By contrast, in relationships with conflict, distance, or less familiarity, participants were hesitant to consider seeking support. Explaining why he would not involve his family, #18 shared,

My family has always been… If they heckle you or make fun or embarrass you about something, it’s as valid as helping. So I just tend not to involve my family with a lot of stuff in that way, especially smoking… It’s just scrutinization that’s unnecessary and not helpful. (#18, M, 24, BC)

Some youth felt uncomfortable disclosing their attempts to quit nicotine vaping since doing so would also reveal their current nicotine vaping habits. As one youth shared, “[my parents] don’t know that I vape… I don’t think they would approve. They probably wouldn’t blame me, it’s just not something I want to share with them. Maybe I will tell them once I have fully stopped which I know I am on the way to” (#3, F, 23, QC).

The presence or absence of trust significantly impacted who youth included in their nicotine vaping and cessation journeys. Several participants felt that trust was a primary condition for them to disclose their attempts to quit nicotine vaping. Similarly, the absence of judgement was a vital condition for sharing. In social networks where participants perceived that they may be judged for their decisions or actions, youth did not feel comfortable seeking support: “I feel like [my grandparents] would kind of judge me despite them smoking at one point in their life, but I would definitely get judgement from them. So I don’t think I would ever go to them about [quitting]” (#1, F, 18, ON). Some youth felt that they were especially likely to receive judgement from their peers at school and work, and were consequently less willing to share their cessation experiences with classmates and colleagues. One youth reflected, “It’s a really sensitive topic, there’s a lot of statements… Kids are mean, people can judge you for that. They can be hypocritical, even though they might do it themselves” (#10, M, 17, BC). The presence of trust or the possibility of judgement significantly impacted youth’s willingness to seek social support.

Certain relationships were perceived as less appropriate than others to discuss quitting nicotine vaping. The professional nature of relationships with co-workers, for instance, could blur professional and personal boundaries:

When I’m at work I walk in the door, I put on a work persona, I have my work life. I leave and my work life goes away and I’m back to my home life. Don’t mix the two because when you start mixing personal life and work life things can get quite messy, and my work environment is just so peaceful, I don’t want to involve any unnecessary kind of drama- I can deal with [quitting] myself. (#7, F, 18, BC)

Other participants felt that peers’ inability to relate or demonstrate understanding of the quitting experience made some relationships less appropriate for seeking support. As #18 shared, “my friend doesn’t smoke or vape, but he’s also really good at disciplining himself. So, I can’t really relate to him… He’s not someone I really talked to about [quitting], because it’s just unrealistic for me to get any advice from him about it” (#18, M, 24, BC). Youth considered the context of the relationship when determining if it was appropriate to share their cessation experiences with a given social network or relationship.

Normalization of nicotine vaping cessation could be helpful in nicotine vaping cessation journey

Despite frequently declining to engage social networks in their nicotine vaping cessation experiences, several participants spoke about integrating nicotine vaping cessation into larger social contexts. These contexts extended beyond participants’ immediate social networks to include their communities and schools, social and traditional media, and society in general. Integrating nicotine vaping cessation into these contexts was considered a way to normalize decisions to quit and access cessation supports. Participants discussed their experiences using cessation supports or being influenced by social norms or discourses. Youth also shared ideas that they felt could enhance normalization of nicotine vaping cessation at societal and community levels, including services, social messaging, and other strategies that could make nicotine vaping cessation discourse and support more common and acceptable. The following two sub-themes capture these ideas and experiences by youth: available nicotine vaping cessation supports and influences help to normalize cessation; and the lack of dialogue around cessation normalizes nicotine vaping.

Available nicotine vaping cessation supports and influences help to normalize cessation

Some youth used nicotine vaping cessation supports available in the community or on social media. All participants who mentioned these supports found them beneficial and accessible. While youth did not explicitly state that cessation supports offered in these social contexts normalized their experiences of quitting, they described feeling encouraged or put at ease by the support of others and frequently used words like, ‘motivating’ and ‘helpful’ to articulate their experiences engaging with others in these contexts. In-person support groups were a source of advice and guidance, and provided comfort from learning about the experiences and challenges of others:

I find [support] groups are really motivating, rewarding… It is comforting, having a person or two be like, yeah man, I’ve been there done that kind of thing, or hearing about worse situations. It’s a double-edged sword where you don’t feel as bad about yourself. (#18, M, 24, BC)

Cessation resources, including counseling and text/phone-based supports enhanced youth’s comfort with quitting while also connecting them to additional cessation programs and resources. Participants expressed appreciation that these resources were available, and felt they encouraged their cessation journeys.

Participants also drew on support in broader social contexts, particularly from ‘influencers’ in social media. Influencers were sources of information and advice about quitting, and offered inspiration and motivation. As one youth shared, “I’ll look [at] people from YouTube that have actually done it before and have tried to quit. So I will really just look at how they did it and gain inspiration from this” (#2, M, 17, ON). Learning about nicotine vaping cessation experiences from social influencers encouraged some youth in their own journeys.

The lack of dialogue around cessation normalizes nicotine vaping

Participants spoke of the need to address nicotine vaping initiation as well as cessation amongst youth. The influence of social norms where nicotine vaping was seen as ‘cool’ inspired some youth to start nicotine vaping; despite this being a common experience, participants felt that peer influence on nicotine vaping or quitting decisions was rarely discussed. Some youth expressed a desire to normalize this common experience by talking about it. For instance, one youth shared that she had started to vape “because it’s cool and also because you feel a void in your life… And it’s all fake. I wish more people would talk about it” (#3, F, 23, QC). Reflecting on the desire to follow social norms, participants suggested that programs and services harness this impetus to promote nicotine vaping cessation instead of uptake amongst youth. If nicotine vaping cessation were to generate the same kind of attention and appeal, it could normalize quitting:

I feel like everybody starts nicotine vaping at a young age because they think it’s cool. But something that I’ve noticed is that programs to quit are so much worse and so much less cool. So I feel like you have to make the solution as attractive as what got them into it in the first place, which is something that I haven’t seen. So… if any type of community group to help stop nicotine vaping or anything could be made cool, I feel like that would help a lot. (#8, M 2, BC)

Social messaging through media and advertising could also help to normalize nicotine vaping cessation by increasing visibility and dialogue around quitting and available supports. #7 reflected,

I would just like to see it more normalized; I never see any advertising of, ‘this is what will help you quit nicotine vaping’. Nicotine vaping is always kind of like, ‘keep nicotine vaping’ is the message that is getting put out. So maybe if there was more advertising, billboards in every single town- here’s this website, here’s this app, here’s how to get off it. A big sign people drive by every day, because people are unaware of the support. They don’t know, because it’s not being talked about. So that needs to happen. (#7, F, 18, BC)

For these youth, larger scale shifts in social perception and discourse were needed; programs and advertising campaigns could both influence and be influenced by these shifts in a feedback loop that could normalize nicotine vaping cessation.

Youth identified the need for more nicotine vaping cessation resources in the community to increase access to cessation support and normalize quitting decisions. Organized support groups could assist youth through the initial stages of quitting, while other participants felt that texting services would make nicotine vaping cessation support easily accessible and therefore more beneficial. Nicotine vaping cessation support could also be offered through formal health services such as a physician or counsellor. However, access barriers, particularly the cost associated with seeing a counsellor, limited youth’s ability to utilize this option. As one youth shared, “I feel like counselling would be very helpful, but it would be a little difficult to do that… All of them you have to pay for” (#1, F, 18, ON). Integrating nicotine vaping cessation into the school context could normalize quitting by increasing knowledge and awareness of nicotine vaping harms and quitting strategies, and creating spaces for peer support and dialogue. One youth suggested several ways that schools could play a key role in normalizing nicotine vaping cessation:

Maybe in school and if it was part of the curriculum to like, ‘what is nicotine vaping, smoking, or any other type of addiction’ if you want to quit. And maybe there should be like a club about that, that could help students or teenagers my age to help overcome that problem. I think that will be a good club. Or maybe even like a volunteer experience. (#2, M, 17, ON).

Such cessation supports were either not accessible or not being utilized by participants but were considered viable approaches to integrating nicotine vaping cessation into community and public contexts, and normalizing youth decisions and experiences of quitting.

Discussion

Main findings

This study makes a significant contribution as it represents the first qualitative exploration of the social experiences of youth who are quitting nicotine vaping. Our findings provide critical insights into the role of social dynamics in the context of nicotine vaping cessation among youth. These insights allow us to better understand the social environment of youth nicotine vapers, how it affects their cessation journey, and how this understanding can enhance intervention and policy efforts.

Overall, our study highlights the complex social influences on youth nicotine vaping cessation, revealing a paradox between the social nature of nicotine vaping initiation and the solitary approach often taken toward quitting. While youth frequently begin or continue nicotine vaping within a social context—driven by peer pressure or the desire to fit in—our findings reveal that their cessation journeys are markedly different, with many preferring to quit independently or expressing that cessation is inherently individualized. This raises important questions about the role of social support and the broader social contexts that either hinder or help in the cessation process.

Because our findings indicate that social influences played a minimal role in their quit journey, it begs the question about whether this primarily solitary approach to quitting is potentially hindering them in their quit success. In light of social support being endorsed as an important element in nicotine vaping cessation among youth [28, 29], and that social support is included in clinical best practice guidelines for smoking cessation [30, 31], it appears that a better balance is needed. On one hand, interventions and policies should entail an empowering approach that leverages this self-accountability (e.g., smartphone apps). On the other hand, we must not lean too heavily on self-driven interventions to support cessation and recognize the broader narratives that are hindering youth from seeking support, including fear of judgement, feelings of shame, and an overall lack of opportunities to talk about quitting in immediate social networks, as well as in broader social contexts (e.g., school, work). In this regard, much work needs to be done to address these barriers to seeking out and receiving social support for quitting nicotine vaping.

One of the reasons that seeking support from friends and family members was a contested topic among youth was because of a lack of trust and concerns about receiving judgment. Moreover, the fear of being unsuccessful in quitting and subsequently letting others down played a critical role in the decision to quit alone. This fear is likely rooted in an awareness of the typically high rates of unsuccessful quit attempts [1], which can create a sense of futility or embarrassment about involving others in their cessation journey. This reluctance to seek support is consistent with existing cessation literature, which highlights the pervasive fear of judgment and failure [32, 33]. In this regard, similar to what was found in previous research [32], youth may be missing the receipt of support that reinforces their self-efficacy, a key ingredient to behavior change [34]. Therefore, resources for family and friends about how to support individuals during the cessation process, including through relapses, are needed.

Youth in this study also talked about the significant social consequences of quitting nicotine vaping. For many youth, nicotine vaping is a means of social interaction; as such, losing the social connection associated with nicotine vaping has been identified as a barrier to cessation in previous studies [35–37]. Our findings expand on this by revealing that some participants were excluded from their friend groups due to their decision to quit, while others voluntarily distanced themselves from friends who vape to avoid triggers. This indicates that the decision to stop nicotine vaping can profoundly impact the social networks of youth, including their closest friendships. In addition to discomfort in accessing social support and disclosing their decision to quit to their immediate social networks, youth in this study described how certain social contexts, like work, were inappropriate places to discuss quitting nicotine vaping. There appeared to be an overall sense among the participants that quitting nicotine vaping was not something you talked about in general and that talking about it was “taboo”.

Youth did talk about the potential benefits of a supportive social environment. Multiple participants described how connecting to others who were simultaneously trying to quit or had quit in the past, regardless of if they were friends or strangers online, provided them with encouragement, guidance, and means to relate to others, which was found to be more helpful than seeking support from non-vapers. Recent studies examining youth preferences for nicotine vaping cessation indicate that social support from their networks is important [28, 29]. However, similar to our findings, other studies have found that this support is ideally from peers who can relate to the quitting experience versus non-nicotine vaping peers [29]. In this regard, opportunities for social support from other vapers who have quit or are in the process of quitting is likely a productive feature in nicotine vaping cessation programming, whether in the form of an in-person support group or an online forum. Creating opportunities for youth to quit with their close friends also appears to be an important path forward, with youth in our study, as well as other studies (e.g., Kong et al., 29) reinforcing the value of this shared journey towards cessation.

Implications and future research

The overall findings of this study suggest that current interventions may not fully account for the social realities of nicotine vaping youth. Many existing cessation supports and programs focus on individual decision-making and the health risks associated with nicotine vaping, but they often overlook the social factors that sustain nicotine vaping behaviour. For instance, youth reported that quitting nicotine vaping often led to social isolation or stigma, as their peers continued to vape. This social cost of quitting can undermine the effectiveness of interventions that do not address the need for alternative social supports, especially if relational dynamics such as closeness, judgement, or trust hinder youth from engaging other social networks in their cessation journeys. This suggests that interventions should target not only individual behaviours but also the broader social networks that influence those behaviours. Therefore, there is a critical need to develop interventions that create environments where quitting is socially reinforced and supported rather than penalized.

In alignment with the findings of Struik and Yang [9], creating emotionally safe environments is crucial for supporting youth in their cessation journeys. Parents, teachers, coaches, and friends should be equipped with skills and resources to provide non-judgmental and empathetic support. Despite the significant need, there is a concerning lack of positive cessation messaging and evidence-based resources available to youth, such as tailored apps or structured conversations in schools. This gap leaves many youth to navigate quitting on their own without the necessary tools or guidance. The absence of targeted support underscores the urgent need for comprehensive, accessible cessation programs that resonate with youth [23].

To further support youth, it is essential to develop non-stigmatizing policies that promote accountability while balancing positively framed cessation messaging and messages of self-love and self-compassion [9]. Schools could implement programs encouraging personal cessation goals alongside counselling services emphasizing resilience and self-care. Such policies can help create a supportive environment that validates the challenges of quitting without adding to the pressure or feelings of failure. Empowering youth to take responsibility for their quitting journey is important, but this empowerment must be paired with supportive interventions that acknowledge the difficulties involved. Peer support groups, digital platforms offering positive reinforcement, and resources that foster resilience can all play a role in helping youth stay motivated and on track. By addressing these gaps and promoting a balanced approach, we can better support young people in their efforts to quit nicotine vaping and lead healthier lives.

Policies targeting youth nicotine vaping need to go beyond simply restricting access to nicotine vaping products. While these measures are important, they are unlikely to be sufficient if the social contexts that encourage nicotine vaping among youth remain unaddressed. Policies should consider ways to shift social norms around nicotine vaping among youth, potentially through public health campaigns that target not only individuals but also peer groups and communities. Policies should aim to reduce the social stigma associated with quitting, perhaps by promoting positive narratives around cessation and providing platforms for youth to share their experiences.

Efforts to normalize nicotine vaping cessation across North America may benefit from mirroring strategies that were used to normalize smoking cessation. The normalization of smoking cessation across the North American landscape was a complex multidimensional transition involving various stakeholders. Despite evidence emerging in the 1950s on the connection between cigarettes and cancer, tobacco industries denied these claims [38]. However, come the 1960s an abundance of evidence emerged on the health risks, and Canada paved the way for a smoke-free North America when Minister LaMarsh publicly announced these risks [38, 39]. Her controversial statement led to a national health conference being held to amalgamate research on smoking and cancer and an anti-smoking campaign was subsequently spread nationwide [38]. This collaboration between research and popular media helped instigate a bandwagon of smoking cessation, highlighting the potential benefits of utilizing popular media today such as social media platforms including Instagram and TikTok to disseminate the health risks of nicotine vaping.

Similar to our national non-smoking week in Canada [40, 41] or the United States annual quit smoking day [42], having an annual quit nicotine vaping day may help normalize cessation and enable individuals to easily access social support. In our study, many individuals discussed how they were part of a nicotine vaping community and quitting outcast them from this community. A quit nicotine vaping day may help alleviate this barrier to quitting allowing individuals to be welcomed to a new community aligning with their cessation goals.

Strengths and limitations

A strength of this study is that it is the first in-depth exploration of how social influences play a role in youth nicotine vaping cessation according to the experiences of youth themselves. Another strength is the sample size, representation of young women and men, and representation in both Eastern and Western provinces in Canada. However, a limitation is that the experiences of non cis gender individuals who vape, and the experiences of those in other provinces have not been captured, limiting the potential transferability of the findings. In addition, because this study is part of a larger study of app users, the findings may be unique to app using youth. This is both a strength in that the sample shares this consistent context, as well as a limitation in that youth who do not use digital supports, like apps, may have experiences not captured in this study. Furthermore, our sample does not have strong representation of youth ages 16 and 17; therefore, our findings may not fully capture the social experiences of youth whereby nicotine vaping is an illegal activity and youth of this age are likely still in high school versus attending secondary school or are working. Finally, due to rapid shifts in intervention and policy development, it is important to recognize that these findings represent the views and experiences of participants in 2022.

Conclusions

This study examined how social influences impacted youth experiences with quitting nicotine vaping. Youth described the minimal input that their social networks had in their cessation experiences, largely due to their choice to quit alone. Also, while being able to relate to others who have quit or are trying to quit was perceived as positive, youth explained that receiving support from those who vape or those within their immediate family and peer networks was contingent on the nature of the relationships (e.g., level of trust). Finally, youth described how talking about quitting was simply not normalized, which was due in part to the lack of cessation supports available to them to date. The results of our study underscore a crucial gap in existing cessation interventions, which often overlook the social dimensions of quitting, and emphasizes the need for comprehensive programs that normalize cessation, reduce stigma, and promote supportive environments. Policies and programs would benefit from fostering social norms that support quitting behaviors and creating accessible resources to empower youth in their cessation journeys.

Authors’ contributions

LS led the study design. DR, RN, TA, and YY conducted data collection. LS, DR, RN, and MT conducted data analysis. KF conducted the literature review and wrote the introduction. All authors contributed to study conceptualization, drafting the final manuscript, and read and approved the final manuscript.

Funding

LS is supported by a Canadian Cancer Society Emerging Scholar Award (grant number 707156) and a Michael Smith Health Research BC Scholar Award (grant number SCH-2023-3195).

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to personally identifiable participant. Deidentified data may be available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was approved by the University of British Columbia’s Okanagan Behavioral Research Ethics Board (#H22-01408), All participants provided informed consent to participate in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.